Healthcare Provider Details

I. General information

NPI: 1487685178
Provider Name (Legal Business Name): INTERNAL MEDICINE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 06/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8895 BROADWAY
MERRILLVILLE IN
46410-7037
US

IV. Provider business mailing address

PO BOX 1293
BEDFORD PARK IL
60499-1293
US

V. Phone/Fax

Practice location:
  • Phone: 219-738-2081
  • Fax:
Mailing address:
  • Phone: 219-738-2081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number StateIN
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL HURWICH
Title or Position: PARTNER
Credential: M.D.
Phone: 219-738-2081